In the last few weeks, the U.S. Congress has voted on key issues and advanced numerous bills through the legislative process. Several of these bills include provisions related to policy priorities of the American College of Surgeons (ACS). Congress is now in recess for an in-district work period and will return to Washington, DC, after Election Day. Upon their return, members of Congress will be faced with voting on any remaining legislation that requires action before January 3, 2019. The following is a summary of key pieces of legislation that have passed and been enacted, as well as the remaining bills for the 115th Congress to consider.
Appropriations “minibus” package
In September, Congress passed and the President signed the Department of Defense, Labor, Health and Human Services, Education, and Related Agencies (LHHS) appropriations package for fiscal year (FY) 2019 H.R. 6157. The “minibus” package includes a $2 billion increase in funding for the National Institutes of Health (NIH), including a $190 million increase targeted toward the National Cancer Institute (NCI). An additional $2 million is allocated for cancer registries to assist with tracking pediatric cancer as outlined in the Childhood Cancer STAR (Survivorship, Treatment, Access & Research) Act, P.L. 115-180, which was enacted in June 2018. The Childhood Cancer STAR Act has been a legislative priority for the ACS and the Commission on Cancer for a number of years.
Several other ACS-supported initiatives are included in the minibus package, including funding for maternal mortality research, programs to address the abuse and misuse of opioids, and children’s hospital graduate medical education (CHGME).
As part of the accompanying report for the minibus package, S. Rept. 115-289, Congress included language urging the Health Resources and Services Administration (HRSA) to study access to general surgeons for underserved populations and to provide a report to the Congress detailing the potential shortages. This language is similar to that in provisions in ACS-supported legislation, the Ensuring Access to General Surgery Act, H.R. 2906/S. 1351, which would direct the HRSA to conduct a study to define and identify general surgery shortage areas and would grant the Secretary of the Department of Health and Human Services (HHS) authority to designate general surgery shortage areas based on the data gleaned from the study.
Opioids
In October 2018, the House and Senate approved and the President signed into law compromise language for the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, H.R. 6. This legislation passed with bipartisan support in the House by a vote of 393-8 and in the Senate by a vote of 98-1.
The SUPPORT for Patients and Communities Act includes proposals that focus on treatment, prevention, safe disposal of opioids, electronic prescribing for controlled substances under Medicare Part D, and enhancement and development for Prescription Drug Monitoring Programs (PDMP). The legislation also calls for studying the effects of existing opioid-related state and federal legislation that set prescription limits, standardizing electronic prior authorization in Medicaid, and controlling the flow of illegal opioids into the U.S.
CHGME
In September, the President signed the Dr. Benjy Frances Brooks Children’s Hospital GME Support Reauthorization Act of 2018, P.L. 115-241, into law. The CHGME program provides funding to children’s hospitals to assist with the training of pediatric physicians. This legislation funds the CHGME program at $325 million a year for five years. In April, the ACS joined a coalition of other health care organizations that sent a letter in support of CHGME funding.
What’s Next
PAHPAI
In September, the House passed the Pandemic and All-Hazards Preparedness and Advancing Innovation Act (PAHPAI), H.R. 6378, which reauthorizes the Pandemic and All-Hazards and Preparedness Act for another five years. The ACS has supported PAHPAI in both the House and Senate because it includes the ACS-supported Mission Zero Act, H.R. 880/S. 1022, which would establish a demonstration project to assist with the regionalization of trauma care. The Mission Zero Act specifically would provide grant funding to assist integrating military trauma care providers into civilian trauma centers and is essential to ensuring trauma care readiness in times of both peace and war.
The House version of PAHPAI also includes language similar to the Good Samaritan Health Professionals Act, H.R. 1876, which seeks to reduce barriers for health care professionals who want to provide volunteer services during a federally declared disaster.
The Senate version of PAHPAI, S. 2852, is awaiting action and is expected to be voted on when senators return after Election Day. Because of differences between the House and Senate bills, a conference committee will be called to iron out the variations before advancing to the President for final action.
Government funding
The government is funded through December 7, and congressional action is required to fund the government past that date. Congress can either pass another continuing resolution that funds the government until a specific date or pass the three remaining appropriations packages for FY 2019 by December 7.
Congressional hearings
Throughout the rest of the 115th Congress, it is possible that congressional committees could convene hearings on the following topics that the ACS is monitoring.
- Physician self-referral/Stark law: The ACS supports the Medicare Care Coordination Improvement Act (H.R. 4206/S. 2051), which provides CMS the authority to waive the prohibitions in the Stark Law and Anti-Kickback Statute for physicians seeking to develop and operate APMs. The bill also removes the “volume or value” prohibition in Stark Law so that physician practices can incentivize physicians to abide by best practices and succeed in the new value-based alternative payment models.
- Maternal mortality: The ACS supports the Preventing Maternal Deaths Act, H.R. 1318/S. 1112, which would address disparities in pregnancy-related mortality and identify ways to make pregnancy safer by authorizing an HHS grant program through the Centers for Disease Prevention and Control that would allow states to establish, maintain, or expand efforts to reduce variations in pregnancy-related care and expand access to health care services. The bill also would establish a demonstration project to compare the effectiveness of efforts to reduce preventable pregnancy-related mortality.
For questions on ACS-related pending legislation or advocacy opportunities, contact Kristin McDonald, Manager of Legislative and Political Affairs, the ACS Division of Advocacy and Health Policy, at kmcdonald@facs.org or 202-672-1512.
